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This online Learning Network provides members with information and support around Quality Improvement (QI), an evidence-based approach that helps primary care free up time to deliver and evaluate initiatives, and embed new approaches more effectively and efficiently into practice.

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Home Office bureaucracy causing 100s of new NHS trained GPs to face hurdles to stay and work in the UK during workforce crisis

GP trainees from overseas should be given indefinite leave to remain in the UK following successful completion of their GP training, the Royal College of GPs said today.

In a letter to Home Secretary Priti Patel (PDF file, 33 KB), the College calls on her to urgently rectify the visa regulations for all trainee GPs from overseas, to stop them facing potential deportation at the end of their specialty training and the NHS losing desperately needed fully-qualified GPs.

The Government made a manifesto promise ahead of the 2019 general election to increase the size of the general practice workforce by recruiting an additional 6,000 GPs, which the Health Secretary has gone on record to admit they are not on target to meet. Governments in Scotland, Wales and Northern Ireland have also made pledges to increase the GP workforce. Yet, bureaucracy is risking hundreds of NHS-trained GPs being lost to the workforce.

In his letter, Professor Martin Marshall, RCGP Chair, writes: "General practice is working incredibly hard, under intense workload and workforce pressures. To meet this growing demand, it is vital to increase the size of the general practice workforce… we need to train more GPs, and recent years have seen significant progress on this front… This success has depended heavily on international medical graduates (IMGs) coming to train and then work as GPs in the UK.

However, he continues: “Unfortunately, current visa regulations mean these trainees face significant bureaucracy if they wish to remain in UK general practice after completing training, putting both their contributions and the NHS's investment at risk."

In England, 47% of new trainees in 2021/22 were IMGs. It costs the NHS around £50,000 a year to fund a GP in training. During training, GP trainees from overseas are sponsored by the statutory education bodies in each of the four nations of the UK but after training most will remain in the NHS delivering patient care – many in under-doctored areas - but need to secure a visa in order to do so. However, the size of GP practices in relation to hospitals, and the three-year duration of GP training act as barriers.

Prof Marshall writes: “GPs are disadvantaged compared to doctors working in other medical specialties. Current regulations allow IMGs to apply for indefinite leave to remain after five years in the UK. As every other medical specialty has training which lasts more than five years, most IMGs can secure indefinite leave to remain while still sponsored by their training body."

There is also the issue that many GP practices, which are often run as small business, do not have sponsorship licences in place, in the same way that hospitals with large HR teams do.

To address this, the RCGP is proposing to the Home Secretary that all IMGs should be offered indefinite leave to remain in the UK on successful completion of GP specialty training.

Professor Marshall writes: "This would put these doctors on an even footing with their peers working in secondary care and would encourage them to continue to live and work in the UK after their training, meaning the NHS's investment is not lost. Such an approach would also make general practice a more attractive career path for IMGs, helping to deliver the Government's commitment to 6,000 more GPs that this country needs.

He continues: "Until this happens, visas for IMGs should also, by default, extend for at least three months after the trainee's expected completion date, to give these newly qualified doctors time to find an appropriate employer, and the employer time to secure a sponsorship licence, if necessary. The Home Office and UKVI should also work with NHS bodies in the four nations to support practices to navigate the process of becoming sponsors, which will likely be new territory for many. These steps will make it easier to match newly qualified international GPs with appropriate employers."

Commenting further on the letter, Professor Marshall said: “It is ironic that IMGs are effectively being penalised and potentially facing deportation because their GP training lasts just three years, not the five years needed to obtain a visa that gives them indefinite leave to remain. These bureaucratic immigration rules are not fit for purpose and need to be updated to accommodate the needs of people who are qualified and willing to work in general practice delivering patient care. As they stand these rules are damaging for the NHS.

“The uncertainty causes additional strain on trainee GPs at a very stressful time in their career, when their focus should be on completing their training and making plans to begin their career working in NHS general practice, hopefully for years to come.

“If all IMGs were offered the chance to apply for indefinite leave to remain in the UK on successful completion of GP specialty training, they would be able to join the GP workforce, providing much-needed care to patients, and helping to alleviate pressures right across the health service.

"At a time when general practice is experiencing the most severe workload pressures it has ever known, it is nonsensical that the NHS is going to the expense of training hundreds of GPs each year who then face potential deportation by the Home Office because of an entirely avoidable visa issue. We cannot afford to lose this expertise and willingness to work in the NHS, delivering care to patients, due to red tape.”